Pain

AcuteChronic

NeuropathicChronic Regional SyndromesPsychological interface

Jonathan Dixon GP Trainer Moorside Surgery Eccleshill.

• Site• Onset• Character• Radiation• Associated symptoms• Timings- how long / timings of recent exacerbations • Exacerbating / Relieving factors• SEVERITY

• Score out of 10?

SOCRATES

Bio-psycho-social factors that interact and modulate the

experience of painHoldcroft A, et al. BMJ 2003; 326: 635-9

VAS – visual analogue scales

Alternative pain scale.

• 67 year old female pain backs of legs getting worse last 6 months.

• Severe RTA as a child as pedestrian.

• What is diagnosis?

VAS Chart 1.

• Male 19 years old, after ,minor horse riding accident 5 years ago. Struggles with work due to symptoms.

VAS chart 2.

Chronic Regional Pain Syndrome

• Female, 35 years. Pain affecting her for 5 years much worse after recent viral illness in last 6 months. Unhelpful pain managemenet behaviours.

VAS chart 3.

Fibromyalgia

• Female 54 years old. Scald injury to left hand in NHS workplace 5 years ago. Mild CP affecting left arm.

Neuropathic pain / CRPS

• Complex regional pain syndrome (CRPS) is a complex and poorly understood condition.

It is typically characterised by segmental limb pain after a (usually) relatively minor injury to a limb but is more severe and lasts much longer than would normally be expected given the injury.2 It may also encompass a range of problems involving one or more of the nerves, skin, muscles, blood vessels and bone. Occasionally, it affects parts of the body other than the limbs and it may also arise in the absence of injury.

It is thought to arise as a result of abnormal sympathetic nerve healing following trauma, although the exact pathophysiology still remains very much a mystery. In theory, it can be divided into two disease entities of differing aetiologies:

• CRPS I - formerly known as reflex sympathetic dystrophy (RSD), this is pain which develops in the absence of identifiable nerve injury.

• CRPS II - formerly known as causalgia (literally meaning 'hot pain'), this develops after injury to a major peripheral nerve.

CRPS (from patient.co.uk)

• Male 46 gradual onset of pain over several weeks present now for 18 months –manual job.

Nerve root compression l5/s1 and OA thumb.